Digital Amputation Research Articles

Evaluation of the Safety of Calcitonin Gene-Related Peptide Antagonists for Migraine Treatment Among Adults With Raynaud Phenomenon

Calcitonin gene-related peptide (CGRP) antagonists have demonstrated tremendous promise in migraine management. However, these medications decrease reflex vasodilatory response, which may lead to exacerbation of microvascular disease in susceptible patients, such as patients with Raynaud phenomenon (RP). To investigate the microvascular complications of CGRP antagonists in patients with underlying RP. This retrospective cohort study was performed from May 18, 2018, to September 15, 2020, in Mayo Clinic Health System patients with Raynaud phenomenon while undergoing CGRP antagonist therapy to treat migraine. Inclusion criteria were age older than 18 years, history of migraine, past or current treatment with CGRP antagonists, and diagnosis of primary or secondary RP. Treatment with CGRP antagonists. The main outcome measure was microvascular complications (eg, worsening RP, digital ulcerations, and gangrenous necrosis) after initiation of treatment with a CGRP antagonist. Patient demographic and clinical characteristics were compared between those who experienced complications and those who did not. A total of 169 patients (163 [96.4%] female; 151 [89.3%] non-Hispanic White; mean [SD] age, 46 [13] years) were identified. Of the 169 patients, 9 (5.3%) exhibited microvascular complications, ranging from worsening RP to gangrene and autonecrosis that required distal digit amputation. Comparative analysis did not find statistically significant differences in demographic or clinical characteristics between the 2 cohorts. All 9 patients with complications were female (mean [SD] age, 40 [12] years). Five of the 9 patients (55.6%) had previously diagnosed RP; in 3 the RP was primary, and 2 it was secondary to scleroderma. The other 4 patients (44.4%) were newly diagnosed with RP. Eight of the 9 patients (88.9%) had chronic migraine; 4 had migraine with aura, and 5 had migraine without aura. The CGRP antagonist agents temporally associated with the microvascular complications included galcanezumab (in 3 patients), erenumab (in 5 patients), and fremanezumab (in 1 patient). The results of this study indicate that microvascular complications of CGRP antagonist use in patients with underlying RP are uncommon. The incidence of serious adverse events, although rare, warrant caution when considering the use of these agents in patients with RP.

Clinical presentations and long term prognosis of childhood onset polyarteritis nodosa in single centre of Korea

Childhood-onset polyarteritis nodosa (PAN) is a rare and systemic necrotising vasculitis in children affecting small- to medium-sized arteries. To date, there have been only a few reports because of its rarity. Thus, we aimed to investigate the clinical manifestations, laboratory findings, treatment, and long-term outcomes in patients with childhood-onset PAN and to evaluate the usefulness of the paediatric vasculitis activity score (PVAS). We retrospectively analysed the data of nine patients with childhood-onset PAN from March 2003 to February 2020. The median ages at symptom onset, diagnosis, and follow-up duration were 7.6 (3–17.5), 7.7 (3.5–17.6), and 7.0 (1.6–16.3) years, respectively. All patients had constitutional symptoms and skin manifestations, while five exhibited Raynaud’s phenomenon. Organ involvement was observed in one patient. The median PVAS at diagnosis was 7 (range: 2–32). Prednisolone was initially used for induction in all patients, and other drugs were added in cases refractory to prednisolone. All patients survived, but three patients with high PVAS at diagnosis experienced irreversible sequelae, including intracranial haemorrhage and digital amputation. In conclusion, early diagnosis and treatment may minimise sequelae in patients with childhood-onset PAN. This study suggests that high PVAS score at diagnosis may be associated with poor prognosis.

National Population Study of the Effect of Structure and Process on Outcomes of Digit Replantation

Surgeon experience, hospital volume, and teaching hospital status may play a role in the success of digit replantation. This study aims to analyze factors that influence digit replantation success rates. We examined patients with traumatic digit amputations, between 2000 and 2015, from the National Health Insurance Research Database (NHIRD) of Taiwan, which comprises data of more than 99% of its population. We measured the number of traumatic digit amputations and success rate of replantation. Chi-square and ANOVA tests were used for descriptive statistics. Regression models were built to analyze the association among patient, surgeon, and hospital characteristics, and replant success. We identified 13,416 digit replantation patients using the eligibility criteria. The overall replantation failure rate was significantly higher in medium- and high-volume hospitals (low-volume: 11%, medium-volume: 17%, and high-volume: 15%, p < 0.001). Teaching hospitals had significantly higher replantation failure rates [(15.5% vs 7.6%), odds ratio (OR) 2.0; confidence interval (CI) 1.1-3.7]. Lower surgeon case volume resulted in a significantly higher failure rate in the thumb replantation (OR 0.89; CI 0.85-0.94). Teaching hospitals had greater odds of replantation failure, owing to being high volume centers and attempting more replantations. However, the effect of residents performing the replantation during their training should be considered. Teaching units are mandatory for resident training; however, a balance should be established to provide training, but with sufficient supervision to achieve optimal replant success. A national protocol to triage digit amputation cases to high volume centers with experienced microsurgeons will help improve the replantation success rate.

Comparing digital replantation versus revision amputation patient reported outcomes for traumatic digital amputations of the hand: A systematic review and meta-analysis.

Adults with traumatic digital amputation (TDA) of the hand may be managed with replantation or revision amputation. To date, there is no systematic review evaluating patient reported outcomes (PROs) comparing replantation versus revision amputation. Three databases (MEDLINE, EMBASE, and PubMed) were systematically searched in duplicate from inception until June 13, 2019 using Covidence software. Studies comparing replantation versus revision amputation outcomes were considered for inclusion. Methodological quality was assessed using Methodologic Index for Nonrandomized Studies (MINORS) criteria. Data were pooled in a random-effects meta-analysis model using Revman software. Certainty of evidence was evaluated using Grading of Recommendations, Assessment, Development, and Evaluations (GRADE). Of 4350 studies identified, 12 retrospective cohort studies met inclusion criteria and compared TDA outcomes for replantation (n = 717; 82.9% male; mean age 40.3) versus revision amputation (n = 1046; 79.8% male; mean age 41.7). The overall replantation survival rate was 85.3%. The average MINORS score was 57% (13.75/24). Replantation of the thumb had a superior Michigan Hand Questionnaire (MHQ) score (+11.88, 95% CI [7.78-15.99], I2 = 21%) compared with revision amputation. Replantation of single non-thumb digits had a superior MHQ score (+5.31, 95% CI [3.10-7.51], I2 = 67%) and Disability of Arm, Shoulder, and Hand (DASH) score (-5.16, 95% CI [-8.27 to -2.06], I2 = 0%) compared with revision amputation. Most patients in the meta-analysis were from Asian populations (87.9%). There is low-quality evidence that thumb replantation achieves superior PROs compared with revision amputation, which may be clinically important. Replantation of single non-thumb digits also yielded superior PROs, which is likely not clinically important and based on very low-quality evidence. Future studies with populations outside Asia are required to determine if PROs vary based on cultural differences toward digital amputation.

Melanoma of the Nail Apparatus: An Analysis of Patients’ Survival and Associated Factors

Background: There are no proper management guidelines for nail apparatus melanoma (NAM). Objective: This study aimed to describe the clinical features, the presence of locoregional and distant metastases and disease-free and overall survival of NAM treated at our institution. Methods: A retrospective cohort review of patients with single, primary localized histopathologically confirmed NAM was performed. Collected data consisted of patients’ characteristics and tumor features. In addition, local recurrence, locoregional metastases, distant metastases, disease-free survival (DFS) and overall survival (OS) were used as the main outcomes in our analysis. Results: Thirty patients with NAM were included. The overall survival (OS) in our patients at 5 and 10 years was 85.6 and 73.4%, respectively. DFS was significantly higher in patients with primary tumor location in the hand and without tumor-infiltrating lymphocytes (p value = 0.01 and 0.04, respectively). The patients with in situ melanoma or Breslow thickness <1 mm had a significantly higher chance of DFS and OS (90.0 and 94.1% at 5 years, respectively) than those with thicker NAM (58.3 and 55.6% at 5 years, respectively). A total of 53.3% of 30 patients underwent primary excision and covering with a full-thickness skin graft, while 13.3% of our 30 patients underwent digit amputation. The patients who underwent excision and covering with a full-thickness skin graft showed a complete overall survival (100% at 5 years). Conclusion: Primary tumor location in the hand and lower tumor thickness might be correlated with better patients’ survival. The study results suggest that total amputation might not be necessary in all NAM cases.

Three-year (2017-2019) activity report of the Replantation Service for hand amputations in Poland.

This article summarises activity of the Replantation Service for hand amputations in Poland in years 2017-2019. Over this period a total of 551 cases of total and subtotal amputations as well as other complex injuries to the hand were referred to the referenced centres. Of these, 330 referrals were accepted and 221 rejected, for various reasons. Among these accepted, there were 165 total (50%) and 131 subtotal (40%) amputations; 34 patients (10%) had other severe hand injuries. Vast majority of the patients constituted young and middle-age males. The most common was amputation of several digits and thumbs - a total of 251 cases (76%), followed by transmetacarpal - 30 (9%), forearm - 23 (7%) and wrist - 20 (6%) amputations. Replantation of amputated extremity was performed in 138 patients (42%), revascularization in 98 (30%) and in 45 (14%) primary repair of the complex injuries. In 26 cases (8%), coverage of tissue defects was performed, and in 23 (7%) primary terminalization. Survival rate was of a mean of 65% for replantations and 85% for revascularizations. Comparing to the previously reported period 2013-2017, the number of treated patients was similar, but structure of injuries differed: number of digital amputations increased (of 22 cases), whereas number of proximal amputations (hand, forearm and arm) significantly dropped (of 50 cases). The importance of Replantation Service, an informal structure, in saving limbs of severely mutilated patients was emphasised.

CHONDROSARCOMAS OF THE HAND: A REPORT OF THREE CASES

Chondrosarcoma of the hand is very rare. We report three observations of chondrosarcoma of the hand, which enable us to make a review of its pathology. The follow-up was up to 2 years.There were two women and one man with an average age of 48 years old (30, 85 and 31). The localisation was phalangeal in two cases and metacarpal in one case, one case followed for chondroma. The three cases were central. X-rays were characterized by the presence of lytic areas with calcifications and in one case, we showed a calcification in the peripheral tissue. Histological diagnosis was made by biopsy (grade 2 in two cases and grade 1 in one case). Treatment consisted of amputation of the finger in two cases. In the case of metacarpal localization, wide resection of concerned ray. The patients showed no local recurrence and no metastatic spread after 2 years.The chondrosarcoma in the hand may due to malignant change in a pre-existing chondroma. He is the most common malignant bone tumor of the hand. This shows that the diagnosis of a chondrosarcoma can only be made in the synopsis of the radiological, histological and clinical findings.The metastasis of hand chondrosarcomas is very rare but has been described. With regard to the local recurrence rate, the data in the literature varies between 11% and 50%. Conservative treatment is difficult due to the small size of the hand, which allows easy spread of the tumor from compartment to compartment.Despite the low metastatic potential of chondrosarcomas of the hand in comparison with other sites, ray resection or digital amputation is recommended to avoid local recurrence. In cases with only local excision, close follow-up is recommended.

Impact of Digit Amputation on Dogs Competing in Agility

Abstract Objectives This work sought to determine the prognosis for dogs for return to athletic function in canine agility competitions after digit amputation. Materials and Methods Data were collected using an Internet-based survey of owners of agility dogs with digit disorders that required amputation. Signalment and physical characteristics were compared between dogs with traumatic and nontraumatic disorders. Athletic performance before and after amputation was assessed subjectively by owner opinion and objectively for eight dogs using competition performance records. Results Problems leading to digit amputation in 46 dogs included acute or chronic traumatic lesions (30 dogs), infection (7 dogs), neoplasia (7 dogs), and cystic lesions (2 dogs). There were no differences in signalment or physical characteristics between dogs with traumatic and nontraumatic disorders. Of the 46 dogs, 39 (84.7%) had returned to agility at the time of the survey and 94.6% of the owners (37/39) were satisfied with performance after amputation. No dog failed to return to agility as a result of the digit disorder or amputation. There was no difference in mean competition speed before and after amputation. Clinical Significance Most agility dogs undergoing digit amputation perform satisfactorily after surgery, although modifications to performance criteria may be appropriate for some.

Effect of Constant Rate Infusion of Tramadol-Xylazine and Pentazocine Xylazine on Acute Pain Response in Xylazine-Pentobarbitone Anaesthetized Dogs Undergoing Digital Amputation

The study evaluated the effect of constant rate infusion of tramadol-xylazine and pentazocine-xylazine on pain in dogs undergoing digital amputation. Twelve mongrel used for the study were randomly assigned to four groups (n=3). Group 1 received loading dose (LD) Xylazine (1mg/kg IV) and Pentobarbitone sodium (Na) (30mg/kg IV) [LD-XP] prior to digital amputation (DA).Group 2 received LD-XP andXylazine (1mg/kg/hr) by constant rate infusion (CRI IV) prior to DA. Group 3 received LD Xylazine (1mg/kg IV), Pentobarbitone Na (30mg/kg IV), CRI Xylazine (1mg/kg/hr) and Tramadol (1mg/kg/hr) prior to DA. Group 4 received LD-XP, CRI Xylazine (1mg/kg/hr) and CRI Pentazocine (1mg/kg/hr) prior to DA. Results of the pain score evaluation showed that at 1, 3, 6 and 24 hours post-surgery (PS), group 4 had the lowest (p

Cortical Reorganization: Reallocated Responses without Rewiring

Summary Is the brain able to reorganise following loss of sensory input? New work on individuals with sight loss shows that, while brain areas normally allocated to vision respond to other sensory stimuli, those responses are unlikely to mean the brain has rewired.

Treatment of hook nails using the Bakhach’s technique: a retrospective study

INTRODUCTION: The cause of the hook nail is the trauma of the hyponychium. The nail plate presents longitudinal hypercurvature of volar concavity, causing functional loss, aesthetics concerns, and pain. OBJECTIVE: To evaluate the research results of 20 medical records of patients submitted to hook nail correction surgeries of traumatic etiologies. METHODS: Epidemiological, cross-sectional, retrospective study of patients’ medical records who were submitted to Bakhach’s surgical technique, from 2010 to 2018, in the Hand Surgery Outpatient Clinic of the Hospital do Servidor Público Municipal de São Paulo. RESULTS: We analyzed 20 affected fingers: 7 were victims of accidents with sharp objects, 5 with press machines, 5 with doors, 1 with window, 1 with motorcycle, and 1 due to a dog bite. The finger with the highest incidence was the middle finger (n=12), followed by the index finger (n=5), and ring finger (n=3). The main complaint was aesthetics (n=11); pain (n=6), and functional (n=3). All cases had type II distal digital transverse amputations and underwent surgical treatment. The reconstruction surgery occurred between 4 and 25 months after the trauma. CONCLUSION: 15 patients were satisfied and two felt pain: one in the distal interphalangeal joint and the other in the hyponychium. The follow-up ranged from 6 months to 2 years.

Upper extremity high-pressure injection injuries with paint thinner: Case reports with review of the literature

<br><b>Introduction:</b> High-pressure injection injuries are rare traumas of upper extremity which can result in high morbidity incompatible with presentation. Clinical presentation right after the injury can be misleading and might cause underrating of the condition. This may lead to latencies in treatment and might worsen the final prognosis of the patients. Prognosis changes according to the material injected, pressure the material is injected, injection site, and time between the injury and the onset of treatment. Digit amputation rates are between 16% and 48% in literature series, and this seems to decrease with early debridement. <b>Materials and Methods:</b> Emergency department referrals are searched retrospectively for patients with high-pressure injection injuries. Four patients were found that were treated for injured with high-pressure injection gun with paint thinner or mixtures. Relevant literature was searched and discussed. <b>Results:</b> Three out of four patients needed amputations (75%). Two patients needed flap surgery for reconstruction: one interpolation and one free flap. The average time from hospitalization to definitive operation was 9.5 days (minimum 6, maximum 15 days). Fingertip injuries resulted in amputations, and amputation level was more proximal than the injury level which was connected to the dissemination of the injected material. <b>Discussion:</b> High-pressure injection injuries can cause devastating results if neglected, and can be overlooked with inexperienced eyes. Usually, there are minimal complaints from the patients on the onset of the injury, but symptoms exacerbate by time. Early debridement in the first 6 h is crucial for lowering amputation rates. Injected material has a great impact on the outcomes, and organic solvents such as paint thinner, paints, diesel, and engine oil have worse outcomes and higher amputation rates. <b>Conclusion:</b> High-pressure injection injuries need emergency surgical intervention and should not be neglected. Delay in treatment of these cases could cause detrimental outcomes.<br>

Clinical outcomes of salvage revision surgery following finger replantation with vascular insufficiency: A retrospective study.

The aim of this study was to analyze the outcomes of revision surgery following replantation of single digital amputations. In this study, first, a total of 403 patients (339 male, 64 female; mean age=28 years; age range=1-76) in whom a single finger replantation was performed were retrospectively reviewed, and then 60 patients with arterial or venous insufficiency in whom revision surgery was performed were reanalyzed. The second finger was observed to be the most injured one (32.8%). Injury type was classified as clean cut (25.3%), local crush (38.7), extensive crush (7.9%), and avulsion (28.1%). When taking the levels of injuries of the artery-only finger replantations into account, one finger (0.8%) was nail distal third, 70 fingers (56%) were nail distal third to lunula, 43 fingers (34.4%) were lunula to distal phalanx basis, 10 fingers (8%) were distal interphalangeal (DIP) joint, and one finger (0.8%) was middle phalanx. Operative revision was performed on 60 (14.9%) fingers. The need for operative revision was arterial insufficiency in 37 fingers (61.7%) and venous insufficiency in 23 fingers (38.3%). The average revision time was 43 (range=6-144) hours. While the average elapsed time for artery procedures was 35.3 (range=8-110) hours, the average elapsed time for vein procedures was 47.1 (range=6-144) hours. Finger survival rates were examined. Injury mechanism, amputation level, the number of artery/vein repairs and methods were examined in all patients and revision patients separately. After the replantations, according to survival analysis, while 342 (84.9%) fingers were operated upon successfully, 61 (15.1%) fingers developed necrosis. In the patients with revision surgery, the survival rate was 78.3%. The need for revision was arterial insufficiency in 37 fingers (61.7%) and venous insufficiency in 23 fingers (38.3%). The revision rate was significantly lower than other injury types in clean-cut cases. In terms of levels of injury, no revisions were required from distal to lunula level, and the highest revision rate was observed at the proximal interphalangeal (PIP) joint level. The results of the present study have shown that early re-exploration can provide a 78.3% success rate and can increase the survival rate from 67.6% to 84.2% following replantation of single digital amputations. Surgical re-exploration seems to be a reasonable salvage for replanted fingers with vascular insufficiency. Level IV, Therapeutic study.

Dorsal Coaptation for the Treatment of Digital Neuroma

The formation of a symptomatic neuroma after digital tip amputation presents a vexing problem. There is currently no procedure that completely and consistently prevents hypersensitive neuroma formation. This report presents the results of a technique designed to limit axon regeneration and mechanical irritation by neuroma excision, dorsal transposition, and coaptation with the corresponding digital nerve. A retrospective chart review was conducted to assess the effectiveness of neuroma excision with dorsal transposition and epineurial coaptation for postamputation symptomatic digital neuromas. Neuromas were excised using a midlateral fish-mouth incision. Digital nerves were mobilized to the dorsum of the digital tip and coapted using 9-0 nylon epineurial suture. The procedure was modified to salvage viable fingernails or to avoid excessive tension. Mass etal's criteria system was used to evaluate effectiveness. Twenty-four patients with painful neuromas of the radial and ulnar digital nerves after traumatic amputation were included. Thirty-two digits underwent dorsal coaptation. This procedure was associated with a result considered good or excellent in 28 of 32 digits. Twenty-seven of 32 digits registered no pain or stump anesthesia after dorsal coaptation. Twenty-five of 32 digits demonstrated no interference with activities of daily living. Twenty-one of 24 patients returned to work. Neuroma excision with dorsal transposition and epineurial coaptation is an effective treatment for postamputation symptomatic digital neuroma. Therapeutic IV.

Analysis on Making of Finger Prosthesis using Amputation Surgery Method

India is a vast country with a large number of individuals in the community with various disabilities. It had been estimated that there are roughly 0.62 amputees in India per thousand population. This translates to close to more than one million individuals with amputations. Digital amputation is a common injury. This very often results in extensive functional disability and a substantial psychological impact. More importantly, the outcome of digital dysfunction is detrimental to the patient's daily activities, such as buttoning a shirt or unlocking a door. Therefore, the overall goal for these patients is to rebuild a finger with the restoration of normal function, stability, length, and sensation. Prosthetic rehabilitation of amputated fingers is an attempt to rehabilitate aesthetics and limitedly function. A prosthesis will be a counterfeit body part that replaces a few of the work and presence of the absent a major aspect. The kind of your prosthetic hand, finger alternately arm will rely on upon the area Furthermore period for your remaining finger or hand Also your practical Also lifestyle necessities. It is critical with impart those exercises that you feel need aid. The separable die allowed the silicone to flow into narrow spaces. Once the mould is filled with silicone, the flask is closed and pressure is applied slowly.

A new approach to analyzing regenerated bone quality in the mouse digit amputation model using semi-automatic processing of microCT data.

Bone regeneration is a critical area of research impacting treatment of diseases such as osteoporosis, age-related decline, and orthopaedic implants. A crucial question in bone regeneration is that of bone architectural quality, or how "good" is the regenerated bone tissue structurally? Current methods address typical long bone architecture, however there exists a need for improved ability to quantify structurally relevant parameters of bone in non-standard bone shapes. Here we present a new analysis approach based on open-source semi-automatic methods combining image processing, solid modeling, and numerical calculations to analyze bone tissue at a more granular level using μCT image data from a mouse digit model of bone regeneration. Examining interior architecture, growth patterning, spatial mineral content, and mineral density distribution, these methods are then applied to two types of 6-month old mouse digits - 1) those prior to amputation injury (unamputated) and 2) those 42 days after amputation when bone has regenerated. Results show regenerated digits exhibit increased inner void fraction, decreased patterning, different patterns of spatial mineral distribution, and increased mineral density values when compared to unamputated bone. Our approach demonstrates the utility of this new analysis technique in assessment of non-standard bone models, such as the regenerated bone of the digit, and aims to bring a deeper level of analysis with an open-source, integrative platform to the greater bone community.

Effect of Hospital Characteristics on Performance of Pediatric Digit Replantation in the United States

Introduction Utilize a national pediatric database to assess whether hospital characteristics such as location, teaching status, ownership, or size impact the performance of pediatric digit replantation following traumatic digit amputation in the United States.Materials and Methods The Kid's Inpatient Database (KID) was used to query pediatric traumatic digit amputations between 2000 and 2012. Ownership (private and public), teaching status (teaching and non-teaching), location (urban and rural), hospital type (general and children's), and size (large and small-medium) characteristics were evaluated. Replantations were then divided into those that required subsequent revision replantation or amputation. Fisher's exact tests and multivariable logistic regressions were performed with p <0.05 considered statistically significant.Results Overall, 1,015 pediatric patients were included for the digit replantation cohort. Hospitals that were privately owned, general, large, urban, or teaching had a significantly greater number of replantations than small-medium, rural, non-teaching, public, or children's hospitals. Privately owned (odds ratio [OR]: 1.80; 95% confidence interval [CI]: 1.06–3.06; p = 0.03) and urban (OR: 2.29; 95% CI: 1.41–3.73; p = 0.005) hospitals were significantly more likely to perform replantation. Urban (OR: 4.02; 95% CI: 1.90–8.47; p = 0.0003) and teaching (OR: 2.11; 95% CI: 1.17–3.83; p = 0.014) hospitals were significantly more likely to perform a revision procedure following primary replantation.Conclusion Private and urban hospitals were significantly more likely to perform replantation, but urban and teaching hospitals carried a greater number of revision procedures following replantation. Despite risk of requiring revision, the treatment of pediatric digit amputations in private, urban, and teaching centers provide the greatest likelihood for an attempt at replantation in the pediatric population. The study shows Level of Evidence III.

Management of amputated digits.

Traumatic digit amputations account for 1% of all trauma admissions and are an important cause of morbidity in young, working people. It is essential that patients are worked up appropriately and referred promptly to a specialist unit for consideration of replantation. This review summarises the acute management of a patient presenting to the emergency department with an amputated digit. It discusses the assessment, initial management in the emergency department, how to make the decision to replant and operative steps.

Nail unit squamous cell carcinoma: updates on diagnosis, surgical approach, and the use of mohs micrographic surgery.

Nail unit squamous cell carcinoma (NSCC) is a malignant neoplasm that can arise from any part of the nail unit including the nail bed, nail matrix, nail groove, and nail fold. Nail unit SCC is the most common malignant nail neoplasm, and yet its diagnosis often is delayed, partly due to the clinical presentation of NSCC mimicking benign conditions such as onychomycosis, warts, and paronychia. Nail unit SCC has a low rate of metastasis; however, a delayed diagnosis often can result in local destruction and bone invasion. It is imperative for dermatologists who are early in their training to recognize this entity and refer for treatment. Many approaches have been used to treat NSCC, including wide local excision, digital amputation, cryotherapy, topical modalities, and recently Mohs micrographic surgery (MMS).

Analysis of Outcomes of Tamai Zone I Digital Replantation in Cases of Severe Crushing Injury

Purpose: Digital replantation has dramatically changed the fate of mutilated injuries of hand. But in case of severe crushing injury in Tamai zone I, it is a contraindication of replantation. This study aims to determine the replantation survival rate in cases with crushing injury.Methods: We retrospectively evaluated patients’ charts and photos from January 2015 to December 2019. There were 294 patients (331 fingers) with digital amputation who underwent surgery. Cases with crushing were divided into petechiae-in-skin group and red-line-sign group and compared with the group without crushing. The relationship of survival rate with factors was evaluated using chi-square analysis.Results: Of these, 199 fingers were defined as severe crushed, and 140 cases with petechiae in skin and 59 cases with red line sign. There was no statistically significant difference in survival rate compared with the group without crushing (p=0.227). Additional surgery was performed more in crushed injury. However, necrotized soft tissue was mainly on margin of amputation, not on crushed area.Conclusion: The presence of crushing did not affect survival rate in Tamai zone I replantation. However, as the degree of crushing was severe, the need for additional surgery increased. We found that the number of anastomosed arteries and veins influences the survival rate. According to our analysis, even if it’s difficult, finding and doing anastomosis as many vessels as possible can make good results.